QUESTIONS&ANSWERS

We understand that there may be questions around some of our services. Here we answer some of those questions by providing the scientific evidence and reasons behind our services. If you have a question you would like answered, please e-mail our head of communications, Alison Best. Alison@tbhivcare.org.Many of these questions and answers relate specifically to press articles and statements from the Deputy Mayor's Office and therefore relate specifically to our Durban site.

Is there scientific support for providing syringe service programmes?

Can you get HIV from a discarded used needle?

How do you reduce the number of needles in public spaces?

Do you have permission to distribute syringes to people who inject drugs?

Do you have ethical approval for this project?

Are you compliant with the regulations on the disposal of medical waste?

Have you consulted with the stakeholders in KZN?

Is TB HIV Care responsible for all the medical waste dumped in Durban?

1. Is there scientific support for providing syringe service programmes?

2. Can you get HIV from a discarded used needle?

In theory, it is possible, but in reality there have been no reports of HIV being contracted from discarded needles anywhere in the world. Infections that result from needles are usually in medical settings or through the sharing of injecting equipment. While it is not pleasant to have these syringes inappropriately disposed of in the community, the risk is of contracting HIV from a discarded needle is virtually zero. I would, however, urge anyone who does step on any sharp object, be it serrated edge of a beverage can, a piece of glass from a broken bottle, a rusty nail or a syringe, to consult with a health professional for further advice. For further information click here.

3. How do you reduce the number of needles in public spaces?

The Step Up Project has taken a number of initiatives to reduce the number of needles in public spaces. Service beneficiaries have shown a willingness to co-operate with the project, and are themselves looking for creative and innovative ways of reducing the number of needles that are inappropriately discarded. In one area a beneficiary made a secure lockable box to hold a sharps disposal container. In Pretoria service beneficiariesasked the project to engage with SAPS on the issue of used needles. This has been done, and rates of return have increased.In order to reduce the number of needles in public spaces we need to:

Work collaboratively, involving all local organisations

Recognise that certain law enforcement actions could have unintended consequences and seek to address these

Notify TB HIV Care of needles found in communities and places where they may be found so we can routinely collect these

Train people in the safe disposal of inappropriately discarded needles

The Step Up Project is committed to making our community spaces more inclusive and safe for all people. Ifyou require any further information, or would like to report inappropriately disposed of needles in your area,please do not hesitate to contact your regional project co-ordinator.

4. Do you have ethical approval for this project?

YES. The TB HIV Care projects have received ethical approval from the KZN Department of Health for research elements that have taken place to enhance the evidence base for KZN DOH to make informed policy – this includes the 2013 RAR study, the 2015 formative assessment and the 2015/16 evaluation of the PWID Project. The relevant approvals are:UWCEvaluation of a demonstration project providing services for people at high risk HIV infection in three cities in South AfricaApproval number 14/7/6

KZN DOH Providing services for people at high risk of infection in three cities in South Africa: a demonstration project and evaluationApproval number 17/16

5. Are you compliant with the regulations on the disposal of medical waste?

Yes, THC is compliant. This issue was first addressed in September of 2015. THC met with Mr Neil Larratt, Deputy Head Pollution Control and Risk Management, and clarified the process used. Subsequently we met with Urban Management, Metro, Solid Waste Disposal and others. This resulted in THC conducting training for Parks, Urban Management and working with municipal structures to respond to needles found within the community.Personal sharps bins are now issued and returns are incentivised.

6. Have you consulted with the stakeholders in KZN?

Yes, numerous other stake-holders have been engaged. We have worked collaboratively in finding solutions to the problems faced by the community people who use drugs, law enforcement health and others. We have held discusssions and engagements with various parties since 2014.

7. Is TB HIV Care responsible for all the medical waste dumped in Durban?

No. There is a long history of inappropriate waste disposal in Durban. For example, on the 25th of April 2017 a number of syringes were found on a beach and reported to be needles from the syringe programme. This was shown to be untrue as these were a different type and brand of syringe. TB HIV Care has a number of ways of minimising waste. There are no such measures for collecting syringes used by insulin dependent diabetics or other similar supplies of syringes for medical reasons.